Provider Demographics
NPI:1316077746
Name:HAYES, KATRINA R (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:R
Last Name:HAYES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HAZEL PATH
Mailing Address - Street 2:STE 2
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3817
Mailing Address - Country:US
Mailing Address - Phone:615-429-7946
Mailing Address - Fax:615-822-9351
Practice Address - Street 1:115 HAZEL PATH
Practice Address - Street 2:STE 2
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3817
Practice Address - Country:US
Practice Address - Phone:615-429-7946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32871041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3695652Medicaid
TN3695652Medicaid